Snoring is one of the most common symptoms associated with Obstructive Sleep Apnea (OSA) and is caused by vibration of soft tissues obstructing the pharynx (back of the throat) during sleep. Snoring can be caused by many factors and is exacerbated when a child is obese, by extra tissue growth restricting the size of the airway. Sleep Disordered Breathing (SDB) is a term used to encompass snoring, mouth breathing and OSA.

Why is snoring so bad?

When you have a head cold, you often feel like you've been hit by a truck when you wake up in the morning. This is because you've been mouth breathing, aka SDB! Children who mouth breathe live with a perpetual "head cold". This reduces their ability to concentrate and function properly. Basically, SNORING SUCKS.

1. Snoring/SDB is a disorder of oral-facial growth.

Studies by Huang & Guilleminault, 2013 found that SDB in non-obese children is a disorder of oral-facial growth. This means that the growth of your child's face can be disordered if they have SDB. GASP!Examples of disordered oral-facial growth can of course be googled, for most dramatic effect. Disordered oral-facial growth can also be described by the following features;- long, narrow face- asymmetrical face- crooked teeth- overbite or underbite- low muscle tone in face- dark rings under eyesAt the very least, the above can result in huge orthodontic bills.

The American Academy of Pediatrics (2012) found that the presence of SDB in infants predicted a 40%-50% increase in behavioral problems at 4 and 7 years old. The same longitudinal study drew connections between SDB and hyperactivity, emotional difficulties and peer difficulties. Read more here.It makes sense. If your child isn't getting a good sleep, how can they be expected to function, interact and emotionally regulate properly?

3. SDB can effect speech and swallowing development.

Huang & Guilleminault, 2013 also found that oral-facial myofunctional dysfunction (OMD) is associated with the recurrence of OSA. This means that OSA is related to abnormal lip, jaw, or tongue position during rest, swallowing or speech. Generally, these kids present to a Speech Pathologist with a tongue thrust swallow and/or a "lisp". Disordered swallowing patterns can cause difficulty transitioning to solids and fussy eating habits in older children.

4. SDB is related to recurring illness in children.

Breathing through your mouth requires your tonsils to filter the air. Your tonsils are only "backup" filters, with your nose being the primary filter. These lazy tonsils don't like doing the job all the time. As a result, they hoard all of the bacteria and VOILA! ...Tonsillitis! Kids and adults who have recurring tonsillitis should rule out possible mouth breathing habits. Kids can also fall behind developmentally if they are sick all of the time.

2. Habit:Mouth breathing can be habitual, caused by thumb or finger sucking, or even asthma.

3. Tongue tie:Structural and/or physiological factors such as a restructed lingual frenum or "tongue tie" can cause the tongue to rest low in the mouth, making it difficult to close the lips. If you try breathing through your nose with your lips open and your tongue sitting over your bottom teeth, its almost impossible not to mouth breathe!As mentioned earlier, obesity can have a huge structural impact (restriction) on the airway, causing snoring/SDB.

How can we fix snoring!?

There are many options and avenues to explore when presented with a snoring child. **It is important to remember that no two children are the same, and to contact a professional before making any decisions regarding your child's snoring. Don't self-diagnose.

1. Allergy testingYep, if your child is allergic to something, its probably blocking their nose, which can lead to mouth breathing! Try and sort out any allergies first, before taking further action. I'm no expert here, but I do know that dairy products are common allergens for blocked noses!

2. Go to an ENT (Ear Nose & Throat Specialist)An ENT can check that your child can actually breathe through their nose! Children with structural issues such as a deviated septum or broken nose may need surgery to allow nose breathing to occur. Children with recurring tonsillitis may need to have them removed.

3. Orofacial Myofunctional Therapy (OMT)Whoa, isn't that a mouthful!OMT is non-invasive therapy. It encompasses exercises and habitual changes to improve the breathing, chewing and swallowing functions, as well as improve resting tongue posture. Camacho et al, 2015 discovered that OMT decreases the apnea index by approximately 62% in children and 50% in adults. Their systematic review concluded that OMT can serve as an adjunct to other obstructive sleep apnea treatments.

4. Pediatric Dentist/ENTWhen appropriate, children may need to visit a paediatric dentist or ENT who is trained in releasing tongue ties. This procedure is called a frenectomy, and can be explained well in this article by Dr Ghaheri.It is important for children to complete pre and post frenectomy OMT to reduce the risk of reattachment. It's basically like going to the physio after a knee reconstruction, if you don't do your rehab exercises, the surgery could relapse!

At SPOT Rural, our speech pathologists are trained in OMT. You can contact us if you are concerned about your child's snoring.

Learning difficulties are... "difficulties in acquiring knowledge and skills to the normal level expected of those of the same age".

Confused and upset parents walk through my door every day. Most of their children have a learning difficulty and many don't realise it. It is my job to unpack what is going on with their child, then provide assessment and the appropriate support to help families to achieve their learning goals.

There is no magic wand that therapists can wave to "fix" the problem. Learning difficulties require long-term, evidence based intervention for a child to realise their strengths and reach their full potential.

Learning difficulties emerge and are caused by MANY different things, e.g; intellectual impairments, sleep disorders, attention disorders, mental health issues, malnutrition, trauma, neglect and behavioral difficulties (to name only a few!). Learning difficulties also, like most things, don't fit into a neat category. They exist on a spectrum, manifesting and presenting in a multitude of different ways.

There is so much GREY AREA surrounding learning difficulties. It's exhausting.

MYTH #1 - Smart people can't have learning difficulties.

It doesn't matter how clever you are, you can still have difficulties learning new things. Research by Tracy Alloway published in the Journal of Experimental Child Psychology, 2010 outlines that an individual can have an average IQ but perform poorly in learning. She focuses on evidence that working memory is a better predictor of academic success than IQ. This means that the people who do the best academically are those that can concentrate, hold information in their mind and manipulate it.

Myth #2 - Teachers should identify all learning difficulties.

Identifying learning difficulties in children is a specialised skill that health professionals; Educational Psychologists & Speech Pathologists are trained in. Whilst some super-teachers with special education backgrounds and oodles of experience are qualified in identifying learning difficulties, Psychs and Speechie's can perform standardised assessments and evidence-based intervention specifically targeting learning difficulties. Australian schools currently do not recognise learning disabilities such as dyslexia. Therefore, teachers are not well supported in identifying and assisting all learning difficulties especially those that unable to be diagnosed.

Myth #3 - ADD & ADHD are not learning difficulties.

Long story short, I would put any child diagnosed with the above disorders "at risk" of a learning disability. It's not rocket science - if your ability to maintain attention is impaired, how are you going to absorb information OR have the chance to retain it? Case closed.

Myth #4 - Children are "lazy".

Personally, I became lazy at school in grade 11 when subjects became hard for me. My attention and working memory just couldn't handle chemistry and biology and my behaviour and grades in these classes plummeted as a result. I didn't complete my homework and it wasn't long before the teacher called my parents - bummer. I would definitely pop myself into the learning difficulty category in this scenario. Imagine your child has these difficulties in year 1, and how their behaviour and response to learning might be? They aren't lazy... school is hard! HELP THEM.

Myth #5 - Learning difficulties are severe.

Nope. Remember I mentioned that "spectrum" earlier? I have listed features of hidden learning difficulties below that are often dismissed!

Inconsistency in performance - the child is able to perform in some environments and not others. Parents might say, "But he can do it!". Their child may have completed the task once, (or a few times), on a day when they were in a good mood, got enough sleep the night before and also ate a full breakfast for once! Unfortunately, inconsistent achievement does not constitute the development of a skill.

Difficulty maintaining friendships - children with learning difficulties can also have difficulty learning social cues and communication skills.

Meltdowns at home or at school - Learning difficulties can put pressure on our kids. If they are having unexplained behaviours, it might be worth looking into.

Concrete thinking - Children who take things literally and find it difficult to grasp abstract concepts.

On the whole, "learning difficulty" is an overarching term encompassing a plethora of issues. If you think your child might have difficulty learning new things, no matter how big or small, consult a professional. It might change their life and yours.

Welcome!

Heidi is a Speech Pathologist and the founder of SPOT Rural. She grew up on a property in south-western Queensland and is passionate about bringing the best health services to the bush! Click here to learn about her.

​Our blog is designed as an information hub for parents, therapists and educators. We produce practical, useful information on child development and well being. ​Click here to contact us.